If you've got back pain, you're not alone. In fact, up to 80 percent of the population will experience back pain in their lifetimes, according to the American Chiropractic Association. Specific exercises, such as "McGill's Big Three," can help.
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Back pain can be caused by a host of factors, such as muscle or ligament injury, poor posture, fractures, arthritis, infection, disc damage, or even cancer. Sometimes it might appear out of "nowhere." Back pain can also occur with trauma, such as after a fall or motor vehicle accident.
While exercise is beneficial for the majority of people with back pain, some conditions can be made worse with certain movements. See a doctor before performing McGill's big three exercises if you have back pain — particularly if you have pain that radiates down your leg, pain that does not improve with rest, or numbness or tingling in addition to your pain.
Got back pain? McGill's Big Three back exercises — the McGill curl-up, side bridge and bird dog — might be the solution for you.
Who Is Stuart McGill?
Dr. Stuart McGill is a researcher and professor who has studied the causes and treatment of back pain for more than 30 years. He has authored hundreds of peer-reviewed journal articles, written four books and authored chapters in many more. He continues to train and educate professionals around the world in his method of treatment.
Health care practitioners, such as physical therapists and fitness professionals, can become certified in the McGill Method through a series of educational sessions, earning the title of "McGill Method Certified." A clinician who demonstrates competency in the treatment of patients using this method can become a "McGill Method Master Clinician" after successfully passing written and "live patient" exams.
Dr. Stuart McGill believes that the key to successful treatment of back pain is to first understand the cause — which is often a cumulative effect of poor movement patterns. And while most interventions include exercises that focus on strengthening the core muscles, it's core muscle endurance that is most important, according to Dr. McGill.
Why the McGill Big Three?
Dr. McGill designed a treatment intervention comprised of three exercises, or the "Big Three" — the McGill curl-up, the side bridge and the bird dog — to build endurance in the muscles of the core and low back that help stabilize the spine.
As Dr. McGill explained to the American Council on Exercise, "True spine stability is achieved with a 'balanced' stiffening from the entire musculature including the rectus abdominis and the abdominal wall, quadratus lumborum, latissimus dorsi and the back extensors of longissimus, iliocostalis and multifidus."
Your spine is made up of stacked bones called vertebrae. In between each bone is a cushion, or spinal disc. These structures absorb shock and support your spine while allowing movement.
As Dr. McGill points out, spinal flexion, or bending forward, places a great deal of stress on these vulnerable structures. Therefore, popular exercises, such as abdominal hollowing and crunches on a stability ball, should actually be avoided. Instead, he suggests leaving spinal flexion for daily activities that require this movement, such as tying your shoes.
But First, the Brace
Before you attempt the McGill big three exercises, you must learn how to properly engage the targeted muscles — your abdominal obliques. McGill refers to this as abdominal bracing, or stiffening the core to stabilize the spine.
- Lie on your back, on a firm surface.
- Bend your knees and place your feet on the floor.
- Place your hands on your hips, with your fingertips in front of your front hip bones.
- Gently press into both sides of your abdomen with your fingertips.
- Tighten your abs as if you are pulling your belly button toward your spine. You should feel the muscles under your fingertips tighten.
Once you have mastered the abdominal brace, practice incorporating it into daily activities — particularly when lifting — to help protect your back.
How to Do Them
To improve the effectiveness of the Big Three exercises and reduce the risk of injury, proper form is crucial. These core stabilization exercises are performed with the low back in a neutral, slightly arched, position, to preserve the natural lordosis curve of the lumbar spine. Even the crunch, which in theory would involve some spinal flexion, is performed with the arch of the low back supported.
Maintain abdominal bracing throughout these exercises, but remember to breathe. If you experience pain while exercising, stop the activity immediately and consult a health care professional.
Move 1: The McGill Curl-Up
At first glance, the McGill curl-up might appear similar to an abdominal crunch. However, lordosis of the lumbar spine is maintained with McGill's exercise.
- Lie on your back, on a firm surface.
- Bend one knee and place your foot on the ground. Keep the opposite leg straight.
- Reach your arms behind you and position your hands underneath your low back. This will help preserve your arch during this exercise.
- Lift your head, shoulder and upper back off the floor, as a unit. Try not to move each area individually.
- Hold this position for 10 seconds, then slowly lower back down.
Aim for 10 repetitions of this exercise, performing five with one knee bent, then the rest with the other knee bent.
Move 2: The Side Bridge
The side bridge works the erector spinae, latissimus dorsi and multifidus muscles in your back; external and internal obliques in your abdomen; your glutes; and as an added bonus, your deltoid and pectoralis major muscles in your chest and shoulders.
- Lie on your side, on a firm surface. Place your forearm on the ground, under your shoulder.
- Reach across your chest with the other hand and place it on the opposite shoulder. This will help stabilize your trunk.
- With your legs stacked on top of each other, bend your knees to 90 degrees.
- Push down through your forearm and bottom knee to raise your body off the ground. You should be in a straight line from your head to your knees.
- Work up to holding this position for 10 seconds on each side.
When this exercise is no longer challenging, stagger your legs slightly and straighten your knees. Press down through your forearm and feet to lift up into the side bridge.
Move 3: The Bird Dog
Although its name is a bit odd, the bird dog exercise is performed on your hands and knees — a position called quadruped. Keep your abs tight throughout this exercise — do not allow your belly to drop toward the ground.
During this exercise, the core muscles are engaged isometrically, meaning they don't actually move. They stabilize your midsection while you move your arms and legs.
- In quadruped, keep your neck straight by looking at the ground between your hands.
- Lift your right arm straight out in front of you until it is parallel to the floor.
- At the same time, squeeze your glutes and lift your left leg straight out behind you until it is parallel to the floor.
- Keeping your right arm, torso and left leg in a straight line, hold this position for 10 seconds. Do not allow your hips to rotate — your pelvis should remain parallel to the ground throughout this exercise.
- Slowly lower back down and repeat on the opposite arm and leg.
If this exercise seems too difficult, or you find that you can't keep your back straight, begin by lifting just your arm, then just your leg, until you are strong enough to move them simultaneously.
Structure Your Workout Properly
McGill's big three exercises are intended to build muscle endurance. Therefore, it's important to structure your workout so that your muscles don't tire too quickly. This can be accomplished with three sets of each exercise, using a reverse pyramid rep/set scheme, according to the American Council on Exercise.
The first set should include the most repetitions, then decreasing repetitions with each additional set. For example, perform eight reps in the first set, six reps in the second set and four reps in the final set.
ACE also explains that as your endurance improves, you can increase the number of reps performed in each set — but continue to reduce the reps at regular intervals to maintain the reverse pyramid format.
While the total number of repetitions performed should be increased as endurance improves, do not increase the amount of time you hold any position during a particular repetition. The side bridge and bird dog exercises should each be held for a maximum of 10 seconds per repetition.
Do the Big Three Work?
A study published in April 2018 by the Journal of Physical Therapy Science compared the effectiveness of McGill's stabilization exercises versus conventional physical therapy for pain, function and range of motion in 30 subjects with low back pain. Subjects in the McGill category performed the big three exercises. Conventional physical therapy interventions included low back stretches and exercises that targeted the abs and back extensors.
Participants in both groups experienced similar improvements in pain, function and range of motion, but the benefits experienced by the patients who performed McGill's stabilization exercises were statistically greater than the group who received conventional treatment.
Based on these results, it is fair to say that there is more than one way to effectively treat back pain. For the best results, consult your doctor and consider seeing a physical therapist for a thorough evaluation and individualized treatment interventions.
- Journal of Physical Therapy Science: "Effects of Mcgill Stabilization Exercises and Conventional Physiotherapy on Pain, Functional Disability and Active Back Range of Motion in Patients With Chronic Non-Specific Low Back Pain"
- American Council on Exercise: "Low Back Exercises: Stuart McGill's 'Big Three'"
- American Chiropractic Association: "Back Pain Facts and Statistics"
- BackFitPro.com: "Medical Publications From Professor McGill"
- BackFitPro.com: "Designing Back Exercise: From Rehabilitation to Enhancing Performance"
- ExRx.net: "Ball Crunch (on Stability Ball)"